A modified alar cinch suture technique. Article (PDF Available) in European Journal of Plastic Surgery 32(6) · December with. Next, small amounts of the solution are injected beneath the alar bases and the nasolabial To control the width of the alar base, an alar cinch suture is used. Secondary changes of the nasolabial region after the Le Fort I osteotomy procedure are well known and include widening of the alar base of the nose, upturning.
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According to a study conducted by Harvey Rosen, increase in alar rim width accompany superior and anterior repositioning of the maxilla [ 7 ].
An Alternative Alar Cinch Suture
Published online Dec Use of the alar base cinch suture in Le Fort I osteotomy: Twenty-eight patients were prospectively randomised into an intervention group where a cinch suture was used, and a control group. This prevents the sutures from sliding back into the tissues. Alar cinch was performed as an adjunct procedure in group 2 patients and results were compared to group 1 which was the control group.
The tip of the nose turns upwards, the naso-labial angle might increase and the maximal alar width increases. In this article, authors report the effect of a new alar cinch suture technique on a sample of 32 patients.
In the edentulous maxilla, where the alveolar crest and the nasal floor converge due to ccinch bone atrophy, the incision should be placed along the base of the alveolar crest. Then the medial and lateral bony buttresses are addressed: The muscles are exposed by grasping the alar facial groove between thumb and index finger.
We think that the procedure performed postoperatively creates a lot of discomfort for the patients; asymmetry due to the knot performed on a side of the nose and not in the midline may result. Aesthetic outcomes were evaluated by the patients, comparing the preoperative photographs with those taken 6 months after surgery; in all the cases, no compliant about nasal base width was recorded.
For every unit increase of intrusion there was 0. Once the needle enters the mouth through the anterior circumvestibular incision, it is passed through the skin; it is again reinserted into the mouth through the same perforation, and the suture is tied down beneath the nasal aperture in the midline.
The width of the alar base was measured before operation, and then at one, and six months. The vestibular mucosa is advanced with a skin hook in the midline to pull suuture soft-tissue envelope anteriorly.
The incision is made at least mm above the mucogingival junction using a scalpel blade sture an electrocautery needle. The needle is retracted through the skin point without leaving it, then returned to the oral cavity again in a medial position.
Many studies have reported secondary morphological changes in the nose, including alar flaring after a Le Fort 1 osteotomy. This compromised space culminates in the naso-labial muscles being pushed laterally and thereby causing an increase in the inter-alar width resulting in post-operative nasal flare.
The needle is then pulled out together with the artery forcep that holds the sutures until the blunt end of the needle is seen.
Recently a number of studies have looked at the stability and clinical outcome of this intervention. Maurice [ 6 ] describes important information stating that rotation of the palate does have significant effect on the soft tissue of the naso-labial region, also stating that changes in the lateral position of the pyriform aperture have significant effect on the soft tissue of the nasal base.
The suture did reduce alar flaring but it also increased the naso-labial angle.
AO Surgery Reference
In the illustration, one suture on each side of the V-Y closure is shown. Conclusion We conclude that Le Fort 1 osteotomy superior repositioning leads to a widening of alar region of the nose, especially the alar base. The first forcep is then removed together with the needle.
They also suggested that a modified cinch suture may result in greater stability. Following this method, the nasal mucosa can be stripped successively. The post-operative results in group 1, compared to pre-op, frontal and sub-nasal view, is depicted in Figs. Thirty adult patients with vertical maxillary excess, who underwent Le Fort 1 impaction, were divided sutute 2 groups of 15 each.
Use of the alar base cinch suture in Le Fort I osteotomy: is it effective?
A line of a local anesthetic mixed with epinephrine 1: This lateral retraction results in flaring, widening and elevation of the base of the nose, which is frequently not symmetric [ 5 ].
Efficacy and stability of the alar base cinch suture. Intergroup comparison was done by independent sample t test and it pronounced the following results: Nasal changes after surgical correction of skeletal correction of skeletal Class III malocclusion in Koreans.
Then the suture is passed through the opposite side in order to create a loop. Br J Oral Maxillofac Surg. Distance measured between the center ccinch the alar bases using vernier caliper. The incision is carried down through the mucosa, submucosa, underlying facial muscles and periosteum ….